Book Review: Lung Cancer Therapy Annual 2000

In an era of information "overload" for the practicing oncologist, keeping up with the latest therapies for the many distinct clinical scenarios that arise in daily practice can be quite a challenge. Thus, a concise synthesis of the current knowledge in a field, such as provided in Lung Cancer Therapy Annual 2000 by Drs. Heine Hansen and Paul Bunn, can be quite useful. These authors, whose clinical expertise and contributions to lung cancer therapy are internationally acknowledged, offer a complete review of the literature pertaining to lung cancer therapy from the year 1999, including a review of abstracts from major meetings. A brief summary is provided at the end, outlining standard, accepted strategies based on histologic and stage-by-stage criteria. This text serves as a reference that summarizes the major existing literature, evaluates the strength of the evidence, and makes reasonable recommendations on how to proceed with clinical care.

The book is divided into 10 chapters ranging from epidemiology and screening/early detection to treatment of small-cell and non-small-cell lung cancer. Written in an easy-to-read format from the viewpoint of the medical oncologist, the chapters are broken down in a clear, logical manner by stage, treatment modality, and strength of trial evidence. For instance, the lengthy discussion of non-small-cell lung cancer treatment addresses diverse but important issues such as early-stage disease, postoperative adjuvant therapy, preoperative neoadjuvant therapy, and chemoprevention, as well as chemotherapy regimens (single agent, combination "doublets" and "triplets") for metastatic disease.

Within each topic, data are well organized and broken down into randomized phase III vs nonrandomized phase II trials. Special topics, such as treatment of elderly patients, those with poor performance status, and those with brain metastases, are addressed separately. Despite the massive amount of information being discussed and the somewhat dry nature of the topic, the reader is able to extract conclusions from each section regarding currently accepted therapies and questions yet to be answered through ongoing clinical trials.

The multiple tables that summarize the pertinent studies in each section of a given chapter are particularly useful. They provide references, the stage of disease being treated, the therapy administered, the number of patients studied, response rates, median survival, and frequently, long-term survival rates. This level of detail allows the reader to use the book as a quick reference.

While the major chapters on the treatment of small-cell lung cancer, non-small-cell lung cancer, and mesothelioma are comprehensive, some of the other chapters are less useful. The text contains occasional inaccuracies, such as defining stage IIB as T2N0M0 or including the bcl-2 oncogene in a table on tumor-suppressor genes while discussing it at length in the section on dominant oncogenes. The chapter on staging is confusing at times, and the chapter on biological therapy focuses more on the prognostic value of abnormalities in protein expression than on therapies addressing these abnormalities.

The essential task regarding a text such as this one is to determine who its audience is. The focus of this book is to summarize the most recent literature with the understanding that the reader is already knowledgeable about lung cancer therapeutics. Most busy practioners are not likely to pick up a textbook to obtain this information; however, if they do, they will find it easy to be up-to-date (that is, up-to-1999) on a variety of special topics pertinent to the care of patients with lung cancer. These days, dissemination of important information on treatment sometimes precedes publication in peer-reviewed journals, and it is increasingly difficult to be aware of all the latest data necessary for patient care. For those willing to take advantage of it, the targeted reviews of specific clinical scenarios provided in this book will ultimately save time.